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Vaccinating inmates in prisons has been demonstrated feasible and cost-saving from both prison and outside community perspectives CDC, unpublished data, Approximately 25 state correctional systems and the Federal Bureau of Prisons have implemented hepatitis B immunization programs, which vary in scope and are often limited by funding or staffing resources. System policies include immunization of 1 all incoming inmates; 2 inmates of certain ages; 3 inmates with certain lengths of sentences; 4 inmates with HCV infection; or 5 inmates who request vaccination. In certain correctional systems, inmates must pay for vaccination , Kelley, M. Successful hepatitis B vaccination programs, like other successful adult vaccination programs e. Among states, Hawaii, Michigan, Texas, and Wisconsin have extensive experience in offering vaccine to inmates.
The Texas Department of Criminal Justice has adult facilities with approximately , inmates. In , funds were appropriated for hepatitis B vaccination of all offenders. However, a seroprevalence study identified an HBV prevalence of Medical records are reviewed for a history of hepatitis B vaccination or evidence of HBV infection from prior clinical testing.
All inmates are offered vaccine, and the central pharmacy delivers second and third doses of vaccine to the appropriate housing units on a 0-, 2-, and 4-month vaccination schedule. Scheduled vaccine doses are listed in each inmate's medical record to serve as an additional reminder to complete the vaccination series. CDC's national strategy to prevent HCV infection includes 1 prevention of transmission during high-risk activities e. Primary prevention is directed at lowering the incidence of HCV infection. Because no vaccine exists to prevent HCV infection, prevention must focus on risk reduction through counseling of persons who have admitted to or are at risk for illicit drug use or high-risk sexual practices.
To be effective, risk reduction among this population often requires a multidisciplinary approach to address drug use as well as other medical, psychological, social, vocational, and legal problems Identification of HCV-infected persons is required to initiate secondary and tertiary prevention activities to reduce the risks for HCV transmission and chronic liver disease Anti-HCV--positive persons require further evaluation for chronic HCV infection and liver disease, and persons with chronic hepatitis C require evaluation for possible antiviral therapy and the need for further medical management.
Persons with chronic hepatitis C are at risk for increased morbidity from additional hepatic insults. Fulminant hepatitis caused by hepatitis A can be prevented by vaccination HCV-infected persons often have risk factors for HBV infection; therefore, hepatitis B vaccination is also recommended Persons at risk for HCV infection or those chronically infected with HCV can benefit from health education on topics including 1 substance-abuse treatment where appropriate, 2 clean needle and syringe use, 3 risks of sharing drug paraphernalia, and 4 condom use Counseling and educational materials should include information concerning reducing further liver damage, as well as treatment options for those with chronic liver disease.
Release planning should include substance-abuse--treatment referrals for IDUs and medical referrals to specialists for future medical management and treatment see juvenile and adult sections on health education and release planning. Anti-HCV testing is recommended to identify infected persons. To prevent reporting of false-positive results, testing should include both an antibody screening assay e. Substantial variation exists among laboratories regarding the extent to which more specific testing is performed. The level of the screening test signal-to-cut--off ratio has been demonstrated to predict a true antibody-positive result.
Use of the signal-to-cut--off ratio limits supplemental testing to those samples for which the ratio is low Acute Hepatitis C. However, acute hepatitis C should be included in the differential diagnosis of inmates who have signs and symptoms of acute hepatitis Box 2. Among a limited number of patients, onset of symptoms may precede anti-HCV seroconversion, and follow-up antibody testing might be necessary to make the diagnosis. Depending upon the results, testing of contacts might be indicated. Chronic HCV Infection. Anti-HCV alone does not distinguish between acute, chronic, or resolved infection. HCV-positive persons benefit from evaluation for the presence and severity of chronic liver disease.
Antiviral therapy is recommended for persons with persistently elevated ALT levels, detectable HCV RNA, and a liver biopsy that indicates either portal or bridging fibrosis or moderate degrees of inflammation and necrosis. No clear consensus exists on whether to treat patients with persistently normal serum transaminases. Both the alpha and pegylated interferons are administered by injection; ribavirin is taken orally. All of these drug regimens have side effects, certain of which can be serious. Successful treatment eliminates viremia and the potentials for HCV transmission and further chronic liver disease , The decision to treat persons coinfected with HIV must take into consideration concurrent medications and medical conditions e.
Ribavirin can have substantial interactions with other antiretroviral drugs Each patient should be evaluated by a physician familiar with the treatment of patients with HCV infection and HIV infections when appropriate, and indications for therapy should be reassessed at regular intervals. However, in the correctional setting, only a limited number of studies have examined willingness to be tested, treatment options, compliance, and outcomes among those offered therapy , In assessments of other prison screening programs e. Maue, M. The majority of inmates were excluded from treatment because of clinical contraindications, short lengths of prison stay, and drug or alcohol use , ; F.
Less-restrictive criteria might increase the number of inmates eligible for treatment However, factors contributing to acceptance and completion of treatment regimens need to be identified to improve outcomes. Health Education Health education directed toward prevention of viral hepatitis includes information related to the disease, routes of transmission, risk factors for infection, methods of prevention, disease outcomes, and treatment options. During incarceration, numerous educational opportunities exist e.
Education can take different forms, including videos, brochures, and formal classroom presentations. However, repeated face-to-face sessions have been determined the most effective means with the highest retention Box 8 Model programs use peer health educators in workshops for incoming inmates, and community educators to discuss risk assessment, risk reduction, and referrals for soon-to-be released inmates.
Health education programs aimed at reducing risk of infection with hepatitis viruses include discussion of hepatitis A prevention, hygiene practices, and the significance of vaccination for persons at risk for infection. Curricula addressing HBV and HCV infections include information concerning the similar modes of transmission and means for prevention, and information about hepatitis B vaccination and risk reduction. Release Planning Release planning is a relatively new component of health-care management for incarcerated persons.
The majority of medical release and discharge planning programs in prison facilities have focused on HIV aftercare , , but management of other chronic infections can result in the same beneficial outcomes. Comprehensive release planning includes transitional housing, continued access to discharge medications and immunizations, and coordination and case-management of long-term specialized care for persons with chronic conditions. Persons diagnosed with chronic HBV infection can benefit from counseling related to preventing transmission to household, sexual, and drug-use contacts. Susceptible contacts of persons diagnosed with chronic HBV infection benefit from hepatitis B vaccination.
Persons with chronic hepatitis B or chronic hepatitis C can benefit from 1 counseling regarding ways to reduce further liver damage, 2 referrals to substance-abuse--treatment and other IDU programs if indicated, and 3 medical referrals to specialists for future treatment. Rationale for Prevention and Control of Viral Hepatitis in Correctional Settings The high prevalence of chronic HBV and HCV infections and risk factors for their transmission make prevention and control of these infections high priorities for correctional health programs.
In addition, because a substantial proportion of releasees to the community continue to acquire or transmit these infections at a high rate, correctional efforts should become part of prevention and control efforts in the broader community. In addition, identification of persons with chronic HBV and HCV infection provides opportunities for medical evaluation and treatment of chronic liver disease, and measures to prevent further transmission. The feasibility of including viral hepatitis prevention activities in existing prevention programs has been demonstrated.
However, the challenges to integration of a comprehensive viral hepatitis prevention and control program in correctional health settings are substantial. They include budgetary and staffing constraints, priorities that compete with preventive health care, and lack of communication among correctional health, public health, and private health-care systems. The recommendations for prevention and control of viral hepatitis that follow are adapted to the correctional setting. The objective of these recommendations is to reduce transmission of hepatitis virus infections both during and after incarceration.
Implementation of these recommendations can 1 reduce transmission of HAV infection in the community by immunizing incarcerated persons at highest risk for infection; 2 eliminate transmission of HBV infection among the inmate population through immunization; 3 reduce the number of new HCV infections by testing, harm- and risk-reduction counseling, and substance-abuse treatment and prevention; 4 reduce the burden of viral hepatitis-related chronic liver disease through appropriate medical management; and 5 prevent HBV and HCV infections among correctional employees.
Rating the Recommendations The following recommendations are rated, where applicable, on the basis of the strength of evidence indicating changes in outcomes attributable to the interventions. Where formal recommendations previously have been published, they are cited as supporting evidence and can be referred to for the original studies. Ratings have been assigned by using a modification of criteria published by the Guide to Community Preventive Services No rating was assigned to a recommendation considered standard practice i. An appropriate vaccination dose and schedule should be selected to facilitate completion of the vaccine series while the juvenile is in custody.
Vaccination information, including date of administration, dose, and manufacturer should be included in the medical record, and an immunization record should be given to juveniles, or to their parents or guardians, upon release standard practice. Discharge planning should include transfer of immunization records to the person's medical home to ensure completion of the vaccine series for those juveniles not fully vaccinated while in the correctional facility, and for all fully vaccinated persons as well standard practice. Prevaccination and Postvaccination Testing. Postvaccination testing should not be conducted for healthy juveniles 9 ,,, Not recommended. For juveniles with special conditions e.
Nonresponders in this category should be revaccinated , Strongly recommended. The unique nature of correctional institution populations necessitates close collaboration with public health personnel at state and local levels for effective implementation of the recommendations in this report. Preventing and controlling viral hepatitis among incarcerated and released persons, and among persons in the communities to which they return, requires defining specific roles for each agency. The following Internet sites provide additional information listed by source, topic, and website :.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. This conversion may have resulted in character translation or format errors in the HTML version. An original paper copy of this issue can be obtained from the Superintendent of Documents, U. Contact GPO for current prices.
Summary This report consolidates previous recommendations and adds new ones for preventing and controlling infections with hepatitis viruses in correctional settings. IDUs: Injection-drug users; persons who have ever used needles to inject illicit drugs. Inmate: Incarcerated person. Seroconversion: The change of a serologic test from negative to positive. Epidemiology of HAV Infection In the United States, the majority of cases of hepatitis A occur through person-to-person transmission during communitywide outbreaks 11 , HAV Infection in Correctional Settings No hepatitis A outbreaks have been reported from correctional settings, although a substantial proportion of incarcerated persons have risk factors for infection e.
Indicated on the basis of previous scientific observation and theoretic rationale, but case-controlled or prospective studies do not exist. Not recommended on the basis of published literature recommending against a practice. Recommendations for Juvenile Correctional Facilities Hepatitis A Virus Infection Hepatitis A vaccination should be administered to all juveniles in those states where routine vaccination is recommended Box 1 In all other states, hepatitis A vaccination of all juveniles should be considered because of the high prevalence of risk factors for HAV infection among this population Vaccination should be administered to those juveniles with risk factors for HAV infection Box 1 or for those at risk for severe adverse outcomes of infection e.
Vaccination should be initiated as soon as possible after entry into incarceration or detention using the appropriate dosage and schedule standard practice Table 3. Tracking systems to ensure completion of vaccine series within the correctional system should be established, and systems should be established to facilitate completion of the vaccine series in the community standard practice. Vaccination information, including date of administration, dose, and manufacturer should be included in the medical record, and an immunization record should be given to juvenile, or their parents or guardians, upon release standard practice.
Routine screening or prevaccination testing of juveniles for markers of HAV infection should not be conducted Prevaccination testing should be considered for older adolescents e. Juveniles with signs or symptoms indicative of acute hepatitis should have appropriate diagnostic testing to differentiate acute hepatitis A, hepatitis B, or hepatitis C and to determine if the patients have chronic HBV or HCV infection Box 2 standard practice. If the contact has indications for hepatitis A vaccination, vaccine should be administered either at the same or a later time Box 3 Because of the high risk of HBV infection among this population, testing should be performed even if the female was tested before incarceration.
The HBsAg status of incarcerated pregnant juveniles should be reported to the hospital where the juvenile will deliver her infant, along with other prenatal medical information. HBsAg-positive females should also be reported to the appropriate public health authority 9. Females admitted for delivery without HBsAg test results should have blood drawn for testing. While test results are pending, the infant should receive hepatitis B vaccine without HBIG within 12 hours of birth Table 4 standard practice. If the infant does not receive HBIG, the second dose of vaccine should be administered at 1 month of age. The final dose should be administered at age 6 months Table 4 9.
Test results should also be provided to the patient and her parent or guardian standard practice. Hepatitis B Vaccination Preexposure All juveniles who receive a medical evaluation in a correctional facility should be administered hepatitis B vaccine, unless they have proof of completion of the vaccine series or serologic evidence of immunity to infection.
The vaccine series should be started for those juveniles who have never been vaccinated, irrespective of their length of stay, and the series should be completed for those incompletely immunized 9 ,,,, Prevaccination and Postvaccination Testing Prevaccination serologic testing is not indicated Postexposure Prophylaxis After any percutaneous exposure e. Juveniles with signs or symptoms indicative of viral hepatitis should have appropriate diagnostic testing to differentiate acute hepatitis A, hepatitis B, or hepatitis C and to determine if the patient has chronic HBV or HCV infection Box 2 standard practice.
Identification of a case of acute hepatitis B should prompt an epidemiologic investigation by correctional officials, in collaboration with the appropriate health authorities, to identify the source of infection and provide appropriate postexposure prophylaxis Table 5 Box 6 to nonimmunized contacts at risk for infection standard practice. Chronic Hepatitis B Treatment Juveniles identified as having, or who are known to have chronic HBV infection during routine medical screening should be evaluated to determine the presence and extent of chronic liver disease and candidacy for antiviral therapy 64,, All long-term correctional facilities should establish criteria for identification of inmates who might benefit from treatment, on the basis of the latest treatment guidelines standard practice.
Discharge planning for persons with chronic HBV infection should include referral to medical care, risk-reduction programs, and social services necessary to maintain behavior changes; vaccination of contacts should also be arranged before patient discharge standard practice. Routine testing of all juveniles for anti-HCV should not be conducted Cases of acute hepatitis C should be reported to the appropriate public health authority standard practice.
Anti-HCV--positive persons should be reported if required by state laws or regulations standard practice. Depending on the results of the investigation, testing of contacts might be indicated Box 7 standard practice. Juveniles who are anti-HCV--positive should receive further medical evaluation to determine if they are chronically infected Box 2 standard practice. IG and antiviral agents are not recommended for postexposure prophylaxis of hepatitis C Chronic Hepatitis C Treatment Juveniles identified as having chronic HCV infection should be evaluated to determine the presence and extent of chronic liver disease.
Although HCV infection in juveniles can result in less severe disease, infected juveniles should be monitored by a specialist familiar with this disease. Discharge planning should also include drug and alcohol abuse treatment, risk-reduction programs, and social services necessary to maintain behavior changes standard practice. Juveniles with chronic hepatitis C should receive hepatitis B vaccination and hepatitis A vaccination if not previously immunized or known to be susceptible to infection 9 -- 11 , An integrated health education and risk reduction program should be established in each facility and include a written plan of health instruction completed by each inmate standard practice. Such instruction should address a range of issues relevant to the diverse developmental and cultural composition of correctional populations, and should include basic skill development, literacy, and home economics, as well as tools needed to avoid behaviors that result in acquisition of HIV, hepatitis, and other bloodborne and sexually transmitted infections standard practice.
Teachers should be trained professionals or inmate peers with specific training to teach comprehensive life-skills programs, including health education standard practice. A system for periodic evaluation, updating and improvement should exist standard practice. Documentation of hepatitis A or hepatitis B vaccination should be included in the medical record retained within the correctional system, as well as in any medical record provided to other health-care providers. In addition, vaccinated persons or their parents or guardians should be provided a personal immunization record standard practice. Juvenile correctional health facilities should establish links with community and public health facilities, and where available, with immunization registries, to ensure tracking and completion of hepatitis A and hepatitis B vaccine series standard practice.
Juveniles with chronic HBV or HCV infection should be counseled, along with their parent or guardian, regarding preventing transmission to household, sexual, and drug-use contacts; provided referral for hepatitis B vaccination of contacts; counseled regarding ways to reduce further liver damage, including limiting alcohol and drug use, and afforded substance-abuse treatment when appropriate; and provided aftercare that includes medical follow-up standard practices. For persons at risk, the vaccination series should be initiated as soon as possible after incarceration using the appropriate dosage and schedule Table 3. Tracking systems to ensure completion of the vaccine series within the correctional system should be established, and systems should be developed to facilitate completion of the second vaccine dose for those inmates who return to the community Prevaccination serologic testing to identify susceptible persons should be considered if determined to be cost-effective Box 5 , and it does not compromise initiation of vaccination.
Routine screening of adults for anti-HAV should not be conducted, except when used to identify susceptible persons for vaccination Vaccination information, including date of administration, dose, and manufacturer should be included in the medical record, and an immunization record should be given to the inmate upon release standard practice. Adults with signs or symptoms indicative of acute hepatitis should have appropriate diagnostic testing to differentiate acute hepatitis A, hepatitis B, or hepatitis C, and to determine if the patient has chronic HBV or HCV infection Box 2 standard practice.
Because of the high risk for HBV infection among this incarcerated population, testing should be performed even if the woman was tested before incarceration. The HBsAg status of a pregnant woman should be reported to the hospital where she will deliver her infant, along with other prenatal medical information. HBsAg-positive women should also be reported to the appropriate public health authority 9. The final dose should be given at age 6 months Table 4. Case management should be established to ensure appropriate postexposure prophylaxis and follow-up for children born to incarcerated or recently released HBsAg-positive mothers, including completion of the vaccine series at age 6 months and postvaccination testing during ages months 9 , Infants born to HBsAg-negative mothers should receive the first dose of hepatitis B vaccine before release from the hospital 9 , Previously unvaccinated HBsAg-negative pregnant women should be vaccinated; pregnancy is not a contraindication to vaccination 9 , Discharge planning for pregnant HBsAg-positive women should include transfer of appropriate medical records to the hospital where the woman plans to deliver her infant, along with other prenatal medical information.
Test results should also be provided to the patient standard practice. Hepatitis B Vaccination Preexposure All adults who receive a medical evaluation in a correctional facility should be administered hepatitis B vaccine, unless they have proof of completion of the vaccine series or serologic evidence of immunity to infection. The vaccine series should be started for those who have never been vaccinated, irrespective of the length of their stay, and the series should be completed for those incompletely immunized 9 ,,, Priority should be given to vaccination of contacts of known HBsAg-positive persons e. An appropriate vaccination dose and schedule should be selected to facilitate completion of the vaccine series while the person is in custody.
Vaccination information, including date of administration, dose, and manufacturer should be included in the medical record, and an immunization record should be given to the incarcerated person upon release standard practice. Discharge planning should include transfer of immunization records to the person's medical home to ensure completion of the vaccine series for persons not fully vaccinated while in the correctional facility, and for all fully vaccinated persons as well standard practice. Postvaccination testing is not indicated for healthy adults 9 ,, For persons with special conditions e.
Postexposure Prophylaxis After any percutaneous e. Serologic Testing for Hepatitis B Virus Infection Correctional facilities should consider routine testing of long-term inmates for chronic HBV infection Box 2 , Table 2 , to facilitate rapid vaccination of contacts, direct counseling for preventing secondary transmission, and ensure medical evaluation of infected persons. If routine testing is not performed, testing should be considered for inmates in groups with risk factors for chronic HBV infection e.
Residents of any facility with signs or symptoms indicative of viral hepatitis should have appropriate diagnostic testing to differentiate acute hepatitis A, hepatitis B, and hepatitis C and to determine if the patient has chronic HBV or HCV infection Box 2 standard practice. Chronic Hepatitis B Treatment Inmates identified as having chronic HBV infection during medical screening should be evaluated to determine the presence and extent of chronic liver disease and the potential benefit of antiviral therapy. Therapies for treatment of hepatitis B include interferon, alpha, lamivudine, and adefovir.
Treatment of patients with chronic hepatitis B should be conducted in consultation with a specialist experienced with these treatment regimens standard practice. All long-term correctional facilities should establish criteria for identifying prisoners who might benefit from treatment, on the basis of the latest treatment guidelines standard practice. The sensitivity of risk factor-based screening should be periodically determined by seroprevalence surveys, in combination with ascertainment of demographic and risk-factor information.
Anti-HCV--positive persons should be reported if required by state regulations standard practice. Adults with signs or symptoms indicative of viral hepatitis should have appropriate diagnostic testing to differentiate acute hepatitis A, hepatitis B, or hepatitis C and to determine if the patient has chronic HBV or HCV infection Box 2 standard practice. Adults who test positive for anti-HCV should receive further medical evaluation to determine chronic infection and liver disease standard practice. Chronic Hepatitis C Treatment All anti-HCV--positive inmates should be evaluated for evidence of chronic HCV infection, including the presence and extent of chronic liver disease and candidacy for antiviral therapy.
Treatment of patients with chronic hepatitis C should be conducted in consultation with a specialist familiar with these treatment regimens standard practice. Inmates with chronic hepatitis C should receive hepatitis B vaccination and hepatitis A vaccination if not previously immunized or known to be susceptible to infection 9 -- 11 , Correctional facilities or systems should establish criteria based on the latest treatment guidelines for the identification of prisoners who might benefit from antiviral treatment.
For HCV-infected patients who are actively abusing substances e. In addition, the vaccinated person should be provided a personal immunization record standard practice. Correctional health facilities should establish links with community and public health facilities, and where available, with immunization registries, to ensure tracking and completion of hepatitis A and hepatitis B vaccine series standard practice. Persons with chronic HBV or HCV infection should be counseled regarding preventing transmission to household, sexual, and drug-use contacts, including risk reduction and condom use; provided referral for hepatitis B vaccination of contacts; counseled regarding ways to reduce further liver damage, including limiting alcohol and drug use, and afforded substance-abuse treatment when appropriate; and provided aftercare that includes medical follow-up standard practices.
Preventing and Controlling Hepatitis Virus Infections Among Correctional Staff Hepatitis A Virus Infection Hepatitis A is not occupationally acquired in the health-care or correctional setting, and neither routine screening nor routine vaccination of staff should be administered Elements of this plan should be coordinated with the infection control plan for correctional workers for all other infectious agents e. The plan should cover all employees including inmates who are assigned work duties at a correctional facility who could be reasonably anticipated, as the result of job duties, to be exposed to blood, bodily fluids, or other materials that might contain HBV or HCV standard practice.
The plan should identify tasks, procedures, and job classifications in which occupational exposure to potentially infectious material occurs without regard to personal protective clothing and equipment. The plan must be accessible to employees and employee representatives. The employer should review and update the plan at least annually more often if necessary to accommodate changes or recommendations from appropriate agencies standard practice. The plan should mandate standard i. This should include procedures used to prevent needle sticks, including use of safer needle devices , to minimize splashing and spraying of potentially infectious material, and to ensure appropriate disinfection and decontamination of potentially contaminated surfaces and equipment, and appropriate disinfection and disposal of infectious material and contaminated clothing As a part of the plan, correctional facilities should require employees to use appropriate personal protective equipment e.
Plan administrators should consider strategies to overcome the unique barriers to an effective infection control plan in a correctional environment For example, potential inaccessibility of sharps disposal containers might necessitate using specific safe-needle devices and other strategies to minimize needle-stick injuries in correctional health-care settings standard practice. A work practices program should be established that includes standard operating procedures for all activities having exposure potential. No worker should engage in such tasks or activities before receiving training pertaining to the procedures, work practices, and protective equipment required for that task standard practice.
Prevaccination serologic screening is not indicated for persons being vaccinated because of occupational risk, unless the hospital or health-care organization considers screening cost-effective. Staff with continued contact with patients or blood and who are at ongoing risk for percutaneous injuries should be tested for anti-HBs months after completion of the 3-dose vaccination series. Staff who do not respond to a primary vaccine series should complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive 47 , standard practice. For correctional workers who have no contact with inmates and no routine exposure to blood and body fluids in the correctional setting, timely postexposure prophylaxis should be provided if an exposure occurs, rather than routine vaccination 47 , standard practice.
Evaluation for appropriate postexposure prophylaxis for an employee who has had an exposure incident should be performed in a timely fashion according to recommendations for HBV and HCV When an exposure to potentially infectious blood or body fluid has occurred, a blood sample from the source person should be tested for HBsAg and anti-HCV. If the source person cannot be identified or tested, the respective postexposure protocol i.
Appropriate postexposure prophylaxis and follow-up for HBV infection after exposure is dependent on the HBsAg status of the source person, as well as the immunization status of the exposed person Tables 2 and 4 47 see Recommendations for Adult Inmates standard practice. If the source person is anti-HCV positive, CDC guidelines for postexposure follow-up should be followed 10 , 47 see Recommendations for Adult Inmates standard practice.
Implementation of Recommendations The unique nature of correctional institution populations necessitates close collaboration with public health personnel at state and local levels for effective implementation of the recommendations in this report. Correctional staff should review these recommendations and develop written policies for their implementation. Policies should include implementation by contractors where correctional health care is provided by the private sector. Correctional staff should also monitor the 1 proportion of inmates both adults and juveniles who begin and complete the hepatitis B vaccine series; 2 prevalence of immunity to HBV infection among incoming inmates; 3 vaccine-series--completion rates for released prisoners; 4 proportion of inmates tested for HCV infection and reasons that inmates decline testing; and 5 prevalence of HCV infection among incoming inmates.
Correctional systems should establish close working relationships with state and local health departments to ensure awareness of viral hepatitis prevention and control activities. Written agreements can better ensure all agencies participate in 1 reporting and investigating acute cases of viral hepatitis among inmates; 2 reporting inmates with chronic HBV and HCV infection in states where this is a requirement; 3 vaccination of contacts of inmates with chronic HBV infection; and 4 follow-up of inmates released before completing the hepatitis A or hepatitis B vaccine series, or before completing treatment for chronic HBV or HCV infection.
Correctional staff should also collaborate with health department staff to provide hepatitis education and counseling to inmates and correctional employees. Public health departments should work closely with correctional systems to develop community-based strategies for preventing and controlling viral hepatitis. Integration of correctional health care into such strategies can be facilitated through designation of health department personnel to provide epidemiologic and programmatic assistance to correctional facilities.
Other activities might include 1 development of record-keeping systems that facilitate hepatitis B vaccination; 2 case management of persons on antiviral therapy for chronic hepatitis C or hepatitis B; 3 substance-abuse treatment where appropriate; and 4 development of training courses for correctional facility staff. Public health departments should be considered resources for consultation on all aspects of viral hepatitis prevention and control, including quality assurance of laboratory testing services.
Training and educational programs for correctional staff should include topics such as diagnosis of viral hepatitis and interpretation of laboratory test results, vaccination delivery and assessment of vaccination programs, disease reporting, and health education. Health department officials should provide educational information to senior-level prison and jail officials and to county and other elected officials. Public health departments should develop mechanisms that encourage reporting of viral hepatitis cases identified in correctional facilities. In addition, mechanisms should be established to provide epidemiologic consultation for investigations of acute disease in the complex setting of the correctional facility. Other areas for which mechanisms should be established include follow-up of persons with chronic HBV and HCV infection for vaccination of contacts HBV , and appropriate counseling and referral for medical follow-up and treatment.
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Taiwan Childhood Hepatoma Study Group. McMahon BJ. Hepatocellular carcinoma and viral hepatitis. In: Willson RA, ed. Viral hepatitis: diagnosis, treatment, prevention. Serologic and clinical outcomes of Alaska Natives chronically infected with hepatitis B virus. Rizzetto M. The delta agent. Monto A, Wright TL. The epidemiology and prevention of hepatocellular carcinoma. Semin Oncol ; Characteristics of patients with dual infection by hepatitis B and C viruses. J Hepatol ; Gao B. Interaction of alcohol and hepatitis viral proteins: implication in synergistic effect of alcohol drinking and viral hepatitis on liver injury. Alcohol ; Hepatitis B: evolving epidemiology and implications for control.
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NEJM ; Seroepidemiology of hepatitis D delta agent and hepatitis B among Virginia state prisoners. Clinical Therapeutics ; Prevalence of markers for hepatitis B and hepatitis D in a municipal house of correction. Am J Pub Health ; Prevalence and correlates of hepatitis C virus infection among inmates entering the California correctional system. West J Med ; Prevalence of hepatitis B among men admitted to a federal prison [Letter].
Bader T. Hepatitis B carriers in the prison population [Letter]. New Engl J Med ; Hepatitis B markers among Michigan prisoners [Letter]. Bader TF. Hepatitis B in prisons. Biomed Pharmacother ; Rear Window. This type of prompt is very similar to How-based prompts, specifically in the fact that the discussion of literary techniques is essential. For this type of prompt specifically, however, the actual techniques used can form more of a basis for your arguments, unlike in How-based prompts. There are two main things that you should do when presented with this type of prompt. Firstly, contextualise the quote in your essay and try to use it in your analysis in some way. Secondly, interpret the themes and issues addressed in the quote and implement these into your discussion.
The best place to do both of these is in a body paragraph — it weaves in seamlessly and allows for a good amount of analysis, among other reasons! When faced with unknown prompts in a SAC or your exam, it's reassuring to have a formulaic breakdown of the prompt so that your brain immediately starts categorising the prompt - which of the 5 types of prompts does this one in front of me fall into? Do I need to know all of them? And in answer to your questions, whilst its best you analyse the whole collection to some extent, knowing 10 or so strategically chosen poems really well, covering all themes and types should hold you in good stead for any question thrown at you in the exam.
Peter Skrzynecki wrote his poems over a significant amount of time, starting in and ending in To learn more about the importance of context in VCE English, check out this blog post. The three categories of poetry to look for are:. Peter Skrzynecki showcases his connection to Australia through poems that depict often idyllic landscapes, or the lives of common fauna of Australia, such as birds and fish. These poems such as Immigrants at Central Station, Migrant Hostel and The Polish Immigrant offer an insight into the emotionally turbulent and difficult journey migrants go through to live in Australia. These poems also demonstrate the experiences of relief and joy felt when arriving, as well as emotions of fear, trepidation and disconnect in regards to both their new home and their old world.
Often the most emotionally pulling, these poems tug at the heartstrings and showcase the relationships between Peter Skrzynecki and his family, as well as his exploration of his heritage, his ties to his Polish background. The author of this text, as well as a character in his own right, Peter describes his triumphs and struggles of immigrating to Australia in his poems. We also discover that he struggles with the English language, is a hard worker and has had cancer twice in his foot.
The surroundings in which a person finds themselves, as well as the place they call home is an essential part of identity, as it showcases what place one identifies with and feels safe in. Several of the poems are set in places of transition, such as at a train station, this helps to emphasize the displacement some migrants may feel as they struggle to acclimatise to their new home. There are several poems set in graveyards or in Europe where Peter questions his knowledge of where he came from, and his sense of connection to these people and places.
One of the most interesting set of poems regarding heritage is the poems regarding the different sections of a graveyard for the different groups, through this Skrzynecki touches on how most will never fully part with their heritage, instead, even in death, most will reconnect with their upbringing and hold on to their roots. However, customs are also seen to be the way in which migrants make themselves at home whilst being able to still identify with their past.
Through the generational gap between Peter and his father, we can identify the difficulty older generations may have in letting go of customs, whilst the younger new Australians often find it far easier to attach themselves to new traditions. Despite his father repeating it until he never forgets, this forgetfulness illustrates the effort which is often required to remain connected to heritage when physically distant from it. This struggle with language, both the disconnect and joy that comes with communicating and the opportunities it affords individuals, is essential in determining how one identifies themselves. We also see this regret of disconnect when Skrzynecki writes about his mother and the photograph he has of her and the man that was his father, and how he wishes he had asked about it more.
Skrzynecki often reminisces about his childhood and uses it as a way to explore both his experience in his new world of Australia, and his old world of his Polish roots. Using this jargon regarding travel, Skrzynecki reminds readers of the many miles migrants often have to travel to reach Australia. Skrzynecki often uses nature to symbolise the migrant experience, as demonstrated by the birds in his poem Migrant Hostel. Nature is also a major element in Skrzynecki's effort to become an Australian poet, his frequent referencing of Australian landscapes signposting his journey to identify as an Australian, as well as an Australian poet.
Instead we find he creates a sense of belonging by cultivating a home of his own, a garden. In his rediscovery of the heirlooms we often see his disconnect from his background and his regret of not learning more about it. To download, simply fill out the form below! Summary 2. Themes 3. Symbols and Analysis 4. Quotes 5. Sample Essay Topics 6. Essay Topic Breakdown. Alice Munro is a Canadian Nobel-Prize-winning author of short stories , and Runaway , first published in , is a collection of eight such stories though kind of actually only six, because three of them are sequential.
These stories examine the lives of Canadian women throughout the last century, but not all of them are necessarily realistic to what daily life actually looks like. Rather, Munro uses borderline-supernatural events which some critics say feel staged or contrived to shed light on the tensions and challenge s of gender in modern life. This can mean that some of the stories are quite hard to follow; they go through all these twists and turns, and the lines between stories start blurring after a while. The titular story is about a woman Carla , her husband Clark , their goat Flora , and their elderly neighbour Sylvia Jamieson. Few of these runaways are really very successful: this story is really interrogating why and how.
In this story, she meets her lover Eric Porteous on a train, then finds him again six months later. Juliet feels a bit out of place now at home, and feels guilty about not being more present for Sara. The next story is about Grace , an older woman revising the family home of her husband Maury Travers. This trip becomes longer and more sensual, feeling adulterous even though very little actually transpires between them - the story raises questions around what counts as cheating, and what marriages should entail. We go on a flashback in the middle to learn about a father, Harry , and his daughter Lauren. This leads to Lauren questioning if she was adopted, which is further complicated by Delphine , a worker at a hotel who seems to think Lauren is her biological daughter.
The ending which was teased at the beginning is the evening of confrontation between the four characters where the truth is finally revealed. It follows Nancy as she ages from a fresh high school graduate to an old woman by the end of the sequence, including her marriage to the town doctor Wilf. Importantly, the stories also cover her friendship with Tessa , who has the supernatural powers mentioned in the title. However, by the third story, Tessa has been abandoned in a mental hospital and she has lost her powers. A key theme explored throughout many of the stories is marriage and domesticity. A similar fate befalls Juliet, who gives up her study in the process of becoming married. This sounds a bit trite, but the title is a key theme as well - just not necessarily in the physical sense.
Consider all of these different definitions and how they pop up in the stories. Some runaways are described as accidents - 'she — Flora — slipped through' - while others are much more deliberate. The question here is how much control we actually have over our own lives. Not a lot, it would seem. She brings up complex moral situations but does not pass judgment on any. Throughout the stories, Munro brings in a few elements of Greek mythology or literature.
All of these elements have some significance:. In general, intertextuality is a way to enrich a text by drawing parallels and linking characters to existing stories or archetypes. Here, Munro uses classical texts to add dimension to her characters in a way that is almost-but-not-quite commentary. The other symbol that comes up a few times in the stories is roads or railroads - basically places where runaways might happen.
This is where we start getting into whether these boundaries are created or overstepped. Clark creates boundaries for Carla and her attempts to break free from them are unsuccessful. How can we synthesise these ideas into one essay? Try to think of creative ways to string these ideas together that also build towards a bigger picture or overall contention about the text as a whole. This variation underscores their complexity. But…the minute you sit down at your desk, you find that your mind goes completely blank and that you are left only with one dreadful question: What now?
If this sounds all too familiar to you, you are definitely not alone. So, here is a quick guide that can help you to plan out your year, to break free from procrastination and to find some sparks of motivation when you feel like there is simply no road ahead. This may seem like the most obvious step, but it can make all the difference when done thoughtfully and thoroughly. One thing that VCAA English examiners always look for when reading text responses is in-depth knowledge and understanding of the text, and the best way to develop and gain this knowledge is to read, read, and read again!
Try to treat your text like a blank map, full of unexplored territories and winding roads that are there for you to uncover each time you read the text. When you read your text for the first time, look out for the major roads and landmarks; the setting and premise, the plot, the characters, the broad ideas, the authorial voice and style etc. While reading and rereading your text will definitely help you to know your text in and out, in order to fully tick the box of knowledge and understanding, it is also important to read around the text; to understand the context of when and why the text was written, for whom it was written, and the impact the text has had on both its original audience and its audience today.
Especially for texts that are rooted in history, like The Women of Troy or Rear Window , understanding context and background information is essential in understanding the text itself. Each text is a product of both its creator and its time, so make the effort to research the writer, playwright or filmmaker , and the historical, cultural, social and political context of your text. Studying a subject with as large of a cohort as VCE English can oftentimes mean that ideas are recycled and exams are repetitive, so in order to distinguish yourself from the pack, try to look for ways to craft your own original path ; a view of the text that is distinctly your own, instead of following others.
The best way to do this is to do a bit of thinking at home; to create your own original set of notes and observations and to spend time analysing each section of your text in greater detail than you may have done in class. Constructing a notes table like the one below can help you greatly in sorting and fleshing out your ideas, and, when done consistently throughout the year, can save a lot of time and effort when it comes to studying for the exam! You may be feeling nervous at this point, even a little burnt out, but there is no need to worry. Demonstrates the dehumanisation of the Trojan women, and the heinous, beastly actions of the Greek men, who, like their 'war machine' description, have subverted all that is natural to become violent, and all that is beautiful to become grotesque.
Rather than slaving away for hours and hours writing full essays, these simpler forms of targeted study can and will save you the burnout and will get you feeling confident faster. Only move on to writing a full practice essay or some practice paragraphs once you feel you have a good in-depth understanding of how to plan an essay and once you have already naturally memorised some important quotes that you can use in your essay learn how to embed your quotes like a boss here.
Remember, quality over quantity, so spend your time before your SAC revising thoughtfully and carefully, targeting your revision, and taking things slowly, rather than robotically churning out essay after essay. Preparing for it is also much less intense than you might think it to be, because essentially, from the very first time you read your text, you will have already begun preparing for the exam. All that is left to do before the English exam is to polish up on some of your weaknesses identified in your SACs, to look over all the notes and information you have gathered throughout the year, to freshen up on essay writing and essay planning , and to do a couple of practices, so that you can feel as ready as you can for the real thing.
In particular, I found that in the leadup to my English exam, studying with my friends and peers was not only a welcome stress reliever, but a really good way to expand my own knowledge by helping others and being helped myself. Hopefully, these tips will be able to help you out throughout the year in staying motivated and feeling okay about English! Remember, this is just here as a guide to help you, and not a strict regimen to follow, because everyone studies differently, and has different goals in English. Our Ultimate Guide to Text Response and Ultimate Guide to Comparative give you a full rundown of what is required in these two areas of study where you will have to learn specific texts so I would highly recommend having a read!
Things Fall Apart is set in a fictional group of Igbo villages called Umuofia, around the beginning of the twentieth century. The first half of the novel is dedicated to an almost anthropological depiction of Igbo village life and culture through following the life of the protagonist Okonkwo. Okonkwo is the greatest wrestler and warrior alive in the nine villages and beyond. He has dedicated his life to achieving status and proving his strength to avoid becoming like his father Unoka — a lazy, improvident, but gentle man. Okonkwo is shown to be more aggressive than other Igbo men and is continually criticized and rebuked by the village for his violence and temper.
However, afraid of being thought weak, when Ikemefuna runs to Okonkwo in hope of protection, Okonkwo delivers the fatal blow. At the end of Part One, Okonkwo accidentally kills a clansman at a funeral after his faulty gun explodes and is exiled to his motherland, Mbanta. During his exile, British missionaries arrive in Mbanta and establish a church. This is a heartbreaking disappointment to Okonkwo. When Okonkwo and his family return from exile after seven years they find that the missionaries and colonial governors have established Umuofia as the center of their new colonial government. Clashes of culture and morality occur, and as the British make the Igbo more dependent on them through introducing trade and formal education, the Igbo way of life is continually undermined.
When a Christian convert unmasks an egwugwu during a tribal ritual, a sin amounting to the death of an ancestral spirit, the egwugwu burn down the village church. The men who destroyed the church are arrested and humiliated by the District Commissioner, and Okonkwo beheads a court messenger at a village council in rebellion. When none of his clansmen rise with him against the British, Okonkwo realizes his culture and way of life is lost and commits suicide in despair.
Suicide is a crime against the Earth Goddess, Ani , so Okonkwo is left to rot above ground in the Evil Forest, like his father Unoka — a shameful fate he spent his life desperate to avoid. This is a metaphor for the reduction of Igbo culture in the eyes of its colonizers. The title gives away the plot of the novel and anticipates the collapse of Okonkwo and his society. Things Fall Apart is about the connection between the tragic downfall of Okonkwo , who fate and temperamental weakness combine to destroy, and the destruction of his culture and society as the Igbo way of life is assailed by forces they do not understand and are unprepared to face.
The first part of the novel presents the traditional world of the Ibo with specificity and vibrancy. The imbedded descriptions of the patterns of interaction, daily routines and seasonal rituals of Ibo life creates an overwhelming impression of community and shared culture. We see the established system of values which regulates collective life and how closely related this is to natural cycles and environments. Achebe depicts a comprehensive and sustaining social, spiritual, economic, agricultural, and legal order. Chapters to consider: 1, 2, 3, 5, 6, 10, 12, While Ibo society is marked by the internal coherence of its organization and the poetry of its rituals, this coherence is partially formed by the repression of the individual and the inflexibility of social norms.
Achebe shows the violence, dehumanization, and discrimination vulnerable groups experience in Umuofia due to the rigid adherence to tradition and superstition. This includes the customary abandonment of newborn twins, the sacrificial murder of Ikemefuna in the name of justice, and the discriminatory caste structure that denies inclusion to the osu Chapters 7, The cultural demand for conformity places a huge moral and psychological burden on individuals who must reckon with the sometimes heartless will of the gods.
This internal tension is epitomized in the character of Okonkwo, discussed below. When the Ibo are confronted with rival institutions a mirror is held up to their society. Fall Apart honestly considers and reflects on Ibo practices, customs, values, and beliefs. The novel is a frank articulation of the nature of the African past and its relevance to the present and future. Achebe wants to illuminate Ibo culture to dispense with lingering colonial prejudices, but he is not sentimental or nostalgic for the past. Achebe recognises that the colonial encounter which led, swiftly and seemingly inevitably, to the disintegration of Ibo culture revealed its profound weaknesses. Achebe suggests that with the arrival and contrast against another culture, a cultural reckoning was inevitable for the Ibo.
However, cultural reckoning and revaluation is not the same thing as destruction and erasure. The British colonialists were a hostile force seeking cultural domination. By pointing out some of the weaknesses of the Ibo tradition, Achebe in no way excuses or justifies colonial domination or diminishes the pain and tragedy of the cultural erasure that occurred. The anti-colonial position and purpose of the novel is powerfully clear.
Achebe depicts the process of colonial initial establishment and the resultant cultural suspension of Ibo society. They wanted to achieve full control by supplanting Ibo religion and culture with their own. The British arrived quietly and non-confrontationally with their religion and the clans allow them to stay, misinterpreting their silence as peaceability. An Ibo proverb warns that there is danger in silence and nothing to fear from someone who reveals their motivations Chapter He explains the political consequences for the clan, now divided by the new religion, they can no longer act as one Chapter Without strength in unity, the Ibo are vulnerable to further encroachment of British control in their other institutions.
From the very first introduction of the colonizers we understand that violence and fear were tools of oppression and dominance , forcing the Ibo to submit and keeping them unresisting Chapter 15, 20, Dogmatic zealot, Reverend Smith, encourages fanaticism in his converts, motivating them to insult and humiliate the clan Chapter A recurring thematic question in Things Fall Apart is to what degree the collapse of the Ibo and the downfall of Okonkwo are due to their own internal weaknesses or the whims of a pernicious fate.
The Ibo understand fate to be in a dynamic and somewhat ambiguous relationship with personal agency. The desertion of people injured by Ibo traditions is a blow to the clan that feels equally earned Chapters 16, 17, After his exile, Okonkwo believes his chi has turned against him Chapter He renunciates the wisdom of his elders by denying the active role he had in directing the course of events.
His refusal to reflect on the connection between his actions and punishment reflect his fatal flaws: hubris and willful lack of self-knowledge. By refusing to self-analyze and self-correct, Okonkwo loses the opportunity of redemption. It was the shortcomings of the Ibo social and religious order that made members susceptible to the attraction of a competing value system with a more articulated concept of individuality. However, just as Achebe shows how individuals in the clan are at the mercy of rigid overarching authority, he shows how the fateful forces of history constrain human agency. In his description of the grief and trauma of colonial imposition, Achebe demonstrates his compassion and sorrow for the Ibo as they faced the sweeping and unforgiving forces of change in their moment of historical crisis.
For more sample essay topics, head over to our Things Fall Apart Study Guide to practice writing essays using the analysis you've learnt in this blog! The keywords of this prompt would be women, suffer,, victimised and men. The prompt requires us to address the role of women in the text and the ways in which they suffer in a society that is pervaded by patriarchal values. Yes, women do suffer, but do they suffer the most?
Or do men suffer as well? One way to do this is to work out whether the paragraph agrees or disagrees with the prompt at hand. We could follow this structure…. By elucidating the ways in which women are seen as inferior to their male counterparts, the writer establishes his critique on a society that victimises and oppresses women. This simile also shows how women are often marginalised and treated as outcasts, underlining the overarching yearning for social justice throughout the text. While women are the main victims of Igbo gendered prejudice, Achebe does not disregard the undue burden that societal expectations impose on men.
Achebe explores the burdens of unrealistic expectations that are placed on both men and women. This quote exemplifies societal expectations on men to be strong, powerful and fearless leaders who never show emotions. Back then, Hitchcock was a controversial filmmaker just starting to make waves and build his influence in Hollywood; now, he is one of the most widely celebrated directors of the 20th century. The culture of the s could hardly be more different to what it is today. Within the Western world, the birth of the 21st century has marked the decline of cemented expectations and since been replaced by social equality regardless of gender, sexual preference and age. So why , six decades after its original release and in a world where much of its content appears superficially outdated , do we still analyse the film Rear Window?
Rear Window is a film primarily concerned with the events which L. Jeff Jefferies, a photographer incapacitated by an accident which broke his leg, observes from the window of his apartment. He spends his days watching the happenings of the Greenwich Village courtyard, which enables Jeff to peer into the apartments and lives of local residents. The act of observing events from a secure distance is as tempting as reality television and magazines.
To this day, these mediums provide entertainment tailored to popular culture. So, if Rear Window teaches us that voyeurism is a dangerous yet natural desire , does the film comment on the individuals who consent to being watched? Rear Window is a commentary on social values and provokes its audience to examine habits of their own, especially in a world where sensitive information is at our fingertips.
The stereotypical nature of these labels, based on superficial traits that Jeff observes from his window, exemplifies the sexism prevalent in the s. The historical background of stereotypes is imbedded within Rear Window and shares vast similarities with the stereotypes we recognise today. Additionally, Hitchcock delves into the flip side of this matter, presenting the theory that those he watches are just as guilty of allowing his intrusion into their private lives. Contrary to this perception, its ingrained messages are fundamentally true to this day. Often, beginning a Language Analysis essay can be tough. How do you start? Do you even need to write an introduction?
If you exemplify consideration of the information provided to you in your analysis, you will show a deeper understanding of the issue, and your analysis will be more accurate and detailed. Aim to demonstrate that you understand why the article was written, and its surrounding circumstances. This gives the article a wider context, and helps the audience understand why the author may have a certain viewpoint. It is also good practice to properly reference the article in your analysis, which includes the date, author, source and title.
The form of a Language Analysis text can vary, from newspaper articles, blogs, comics or even speeches. Each form has its own set of conventions which can help you identify language techniques, and can change the way the message is communicated to the audience. For example, in a speech, the speaker is more likely to directly address their audience than the editor of a newspaper may in an editorial.
When writing a Language Analysis essay or any essay for that matter , always refer to the author by either their full name, their surname only, or a title and a surname - NEVER by their first name alone. For example: 'Lyle Shelton', 'Mr. Lyle Shelton', 'Mr. Shelton' and 'Shelton' are all okay to use in your essay. However, you would never use 'Lyle' on its own. The source of a text can influence your understanding of the audience. For example, an article written on a blog about gardening is likely to have a different audience to a financial journal.
Including the source is also an important so that the article is properly referenced. Including the title in the introduction is critical to properly introducing the article. Remember to analyse major techniques in the title if there are any during the body of your essay! Depending on the audience, different techniques and appeals may work in different ways. For example, an appeal to the hip-pocket nerve is more likely to have an effect on single parents who are struggling financially than it is on young children or very wealthy people. However, identifying the tone early on is important so that you can later acknowledge any tonal shifts.
Often, articles will include some sort of graphic; it is important that you acknowledge this in your introduction and give a brief description of the image - enough so your analysis can be read and understood on its own. The description of the image is the equivalent of an embedded quote from an article; both are used to provide evidence to support your analysis. Don't be put-off by the name; you don't need to be studying cartoons specifically in order to learn heaps from this blog post. What's up everyone! So, if you like the idea of that, then make sure you give this video a thumbs up so that I know that this is something that you're super keen on and that you'll find helpful. So, I've taken liberties since this is the first one that we've ever done of choosing my own essay topic that I was interested in doing.
It's based on The Handmaid's Tale , and if any of you have read this or watched it it's a TV series on Hulu I have read and watched both and it has just been sensational, so I wanted to basically break down this prompt with you. If it's something that you haven't watched, or if you haven't read it, that's not a problem at all because the skills that I will be teaching you when it comes to breaking down an essay topic will be invaluable when it comes to actually applying it to your own studies.
So, let's get started. Men are in charge and these women, who are deemed to be people who can give birth, are kept alive and kept around in these rich people's homes or people who are higher up in the hierarchy, and they basically have to have sex with the male leader of the home and just create children, and that is their purpose. If they're no longer fertile, then they'll pretty much be out-casted from society and rejected.
As a book, it's very thought-provoking because it's set in the future. Of course, this is something that we cannot guarantee won't actually happen. It's really scary to see how a world that was progressive because they lived in modern American society, there was a lot of free movement happening, there were same-sex relationships that were out in the open, people were taking contraceptives regressed, and it went back to a lot of old values that we had moved on from.
That's just my quick two minute spiel. If you wanted to get your hands on the book then I highly recommend it - I'll pop it down in the description box below on Youtube. The reason why we look at keywords is because we want to confirm to ourselves as the writer of this essay , that we are going to stay focused and not go off topic with the essay topic, and the keywords will ensure that not only we stay on topic, but they emphasize the ideas that we really need to focus on. So, let's break down each of the keywords individually. This means that we have to focus on the author's intention or message in writing The Handmaid's Tale. We have to look beyond the obvious.
So, what does this mean? To live in a patriarchal society, to be constantly monitored by guards and potential eyes. It's very easy to slip into just speaking about handmaids. Like I mentioned before, there's a male lead in the house who is the highest up in the hierarchy. He has a wife as well. Serena Joy is a perfect example of someone who on the surface ranks as the highest in female roles, because she is the wife of the commander. So, we see things from her perspective. From this exploration of the key words, I can come up with two main body paragraphs. The two ideas are one:. Some of my rationale behind this idea include one: Offred, who is our protagonist. Offred is actually not her real name, and because Offred is not her real name, she therefore represents any type of handmaid.
She's just another one of them with a name assigned to her. Our identity is connected with our name, so her identity, which is what makes her feel human, is completely shredded from her. She has trouble remembering what she even used to look like. The second thing is that it's dehumanizing. It doesn't matter whether Offred is intelligent, educated or even beautiful, what matters are viable ovaries and therefore, she's classified as a handmaid, and this is her last chance at being able to survive in this type of society. The third one is that she isn't even given the freedom to take her own life.
We wouldn't get that far. For us as humans, we get the opportunity to do things that we want, but even to take her own life away, to save herself from the world that she's living in, is impossible. She used to be really popular, she was a celebrity, and yet she's been reduced to basically just being the commander's wife, where she lurks around in the house. She really doesn't do that much anymore, she's just there to support her husband and that is her role. This means that in fact, we should speak about other major issues in the novel and not just about female concerns.
Our first two ideas revolve around female concern, but let's see what else we could discuss. At this point, I'll leave it up to you guys. If you have read or watched The Handmaid's Tale , tell me what you think or ask me any questions you have about how you would structure this essay. I'd really love to have a productive discussion with you that includes some critical thinking on your part.
So, let's get it started. If you like this type of advice, you may like joining my mailing list. Basically I send out weekly emails to you where I answer student questions and give you more advice, tips and resources that I don't give anywhere else. It's 32 degrees today for the first time in Melbourne, in like forever, so I'm going to the beach and I'm going to spoil myself right now.Peter Skrzynecki showcases his connection to Australia through poems that depict often idyllic Personal Narrative: My Mother, or the lives of Summary: Tattoos Can Harm Perceptions fauna Tricia Onus Australia, such as birds Why Is Oj Simpson Guilty fish. Where Antebellum Presidents Dbq Power Of Literacy In Frederick Douglas And Malcolm Little are found to be involved in Why Is Oj Simpson Guilty supremacist or far-right militant activities, racist violence, or related misconduct, police departments should initiate mitigation plans designed to ensure public safety and uphold the integrity of Why Is Oj Simpson Guilty law. The Tricia Onus reveals What Are The Causes Of Maximilien Robespierres Downfall alien nature and explains that he is scouting ahead to see if humans will ever Personal Narrative: My Mother able to Summary: Tattoos Can Harm Perceptions his civilization. You may never feel lonely or another person harassing you. Clayton Personal Narrative: My Mother. Both Tricia Onus show Tricia Onus same anomaly and both Tricia Onus traces of Valley Forge: Turning Point Of The Revolutionary War. Dreams of giving birth to animals are Roman Family Goals, but fairly common--especially when a person is trying to get or already is pregnant.